Noninvasive assessment of liver fibrosis in patients with Fontan circulation using transient elastography and biochemical fibrosis markers
Noninvasive assessment of liver fibrosis in patients with Fontan circulation using transient elastography and biochemical fibrosis markers
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DOI：
10.1016/j.jtcvs.2007.09.039
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发表时间：
2008-03-01
影响因子：
6
通讯作者：
Abdul-Khaliq, Hashim
中科院分区：
文献类型：
--
作者：
Friedrich-Rust, Mireen;Koch, Constanze;Abdul-Khaliq, Hashim
目的：研究表明，方丹循环衰竭患者可发展为肝硬化并伴其后遗症。因此，纤维化的早期检测对于识别高危患者至关重要。在许多研究中，瞬时弹性成像已被评估为肝纤维化的无创分期。方法：39例接受Fontan手术的患者被纳入研究。所有患者均行腹部超声、瞬时弹性成像和详细的实验室检查。常规超声心动图评估血流、流出及心室功能。结果：39例患儿中36例采用弹性成像法，28例采用生化纤维化指标。瞬态弹性图测量的肝脏硬度与Fontan手术后的时间间隔之间的Spearman相关系数非常显著（0.514,P = 0.001）。结论：目前的研究表明，接受Fontan手术的患者发生肝纤维化和肝硬化的风险增加。风险随着患者的年龄和Fontan手术后的时间间隔而增加。使用瞬时弹性成像和纤维化标志物评分对肝纤维化进行无创测量，可作为识别高危患者和无创监测的有用工具。
Objective: Studies have shown that patients with failing Fontan circulation may develop liver cirrhosis with its sequelae. Therefore, early detection of fibrosis is essential to identify patients at risk. Transient elastography has been evaluated for noninvasive staging of liver fibrosis in a multitude of studies.Methods: A total of 39 patients who underwent the Fontan procedure were included in the study. All patients underwent an abdominal ultrasound, transient elastography, and detailed laboratory testing. Conventional echocardiography assessment of inflow and outflow and ventricular function were performed.Results: Significant signs of liver fibrosis were found in 36 of 39 children according to the elastography method and in 28 of 39 children according to the measured biochemical fibrosis markers. The Spearman correlation coefficient between the liver stiffness measured with transient elastography and the time interval since the Fontan operation was highly significant (0.514, P = 0.001).Conclusion: The present study shows that patients who undergo the Fontan procedure are at increased risk of developing liver fibrosis and liver cirrhosis. The risk increases with the age of the patient and the time interval since the Fontan procedure. The noninvasive measurement of liver fibrosis using transient elastography and fibrosis marker scores can be a useful tool to identify patients at risk and for noninvasive surveillance.